Healed Tendons and Dressage Demands

Q: One year ago my 10-year-old Hanoverian gelding suffered severe cuts on both lower hind legs, including the tendons, in an accident involving a wire fence. The wounds have healed—my horse received treatment in a hyperbaric chamber—but I’m wondering whether the recovered tendons are as flexible as they were before. My horse shows no signs of lameness and is trained to Fourth Level. Do I need to be careful with collected movements?

Name withheld by request

Charles Arensberg, VMD

A: It’s understandable that you are concerned about your horse’s healed tendons. Both the superficial and deep digital flexor tendons are essential to storing elastic energy, which can translate into the gorgeous movements of dressage.

Presumably, your horse’s superficial digital flexor tendons took the brunt of the injury as they lie immediately below the subcutaneous tissue of the legs. These tendons in particular help support the fetlock joint. A typical wire injury severs fibers in the plantar, or back, aspect of the tendon.

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I am interested to hear that your horse’s injuries were treated with hyperbaric oxygen therapy (HBOT). My practice owns and operates an HBOT chamber in partnership with an equine therapy center. Severe wounds and infections benefit greatly from the healing properties of oxygen in conjunction with antibiotics given directly into the blood vessels of the injured limbs in a treatment referred to as regional limb perfusion.

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Your concern regarding the flexibility of the healed tendon tissue is an important one. A slow and meticulous rehabilitation program, involving controlled exercise to cyclically load the healing tissue and remaining tendon fibers, can reduce the risk of scar-tissue formation within the tendon. With six to eight months of rehabilitation, tendon tissue will achieve its maximum strength. If you are now training at Fourth Level again, one year post-injury, most likely you will be able to continue to move forward with training and competition. That being said, a risk for re-injury will always be present because of a weak point at the junction of the healed and normal tissue.

Although collected movements will certainly add strain, tendon injuries in the hind end have a dramatically better prognosis for recovery and the horse’s return to athletic function. In Fourth Level, Test 3, for instance, I would be most conscientious about your horse’s comfort in both the collected canter into working half pirouettes in canter (specifically with the lowering of the haunches) and the tempi changes every fourth stride.

As you proceed, watch for signs of tendon inflammation including heat, swelling, pain on palpation and lameness. Also be vigilant in having your veterinarian perform regular ultrasound examinations to methodically follow the structural integrity of the tendons. This can act as an early warning system to alert you to whether you may need to back off training and competition.